title: The clinical status and survival in elderly dialysis: example of the oldest region of France.
abstract: BACKGROUND
  The number of elderly (≥75 years) patients with end-stage renal disease (ESRD) has increased markedly, including in the Limousin region, which has the oldest population in France. We retrospectively compared outcomes in elderly and non-elderly ESRD patients who started dialysis during two time periods.
  
  
  METHODS
  Baseline clinical characteristics, care, and survival rates were assessed in 557 ESRD patients aged ≥75 and <75 years who started dialysis in 2002-2004 and 2005-2007. Survival curves and Cox proportional hazards model were used to assess survival and factors associated with survival.
  
  
  RESULTS
  Of the 557 patients, 343 and 214 were <75 years and ≥75 years, respectively. Dialysis was started in 2002-2004 and 2005-2007 by 197 and 146 patients <75 years, respectively, and by 96 and 118 patients ≥75 years, respectively. Median age (73.4 years [interquartile range [IQR] 61.7-79.5 years] vs 69.5 years [IQR 57.4-77.4 years] p = 0.001) and the proportion aged ≥75 years (44.7% vs 32.8%, p = 0.004) were significantly higher in 2005-2007 than in 2002-2004. Improved initial status during 2005-2007 was observed only in patients ≥75 years, with a decrease in some co-morbidities, improved walking and better preparation for dialysis. Mortality rates were significantly lower in 2005-2007 than in 2002-2004 (hazard ratio 0.81, 95% confidence interval 0.69-0.95; p = 0.008), with the difference due to factors associated with clinical status and care.
  
  
  CONCLUSIONS
  Improved initial clinical status and better preparation for dialysis, accompanied by increased survival, were observed for patients ≥75 years who started dialysis more recently, perhaps because of early referral to a nephrologist.
authors.forename: Florence
authors.initials: F
authors.lastname: Glaudet
authors.forename: Carine
authors.initials: C
authors.lastname: Hottelart
authors.forename: Julien
authors.initials: J
authors.lastname: Allard
authors.forename: Vincent
authors.initials: V
authors.lastname: Allot
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bocquentin
authors.forename: Rémy
authors.initials: R
authors.lastname: Boudet
authors.forename: Béatrice
authors.initials: B
authors.lastname: Champtiaux
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Charmes
authors.forename: Monica
authors.initials: M
authors.lastname: Ciobotaru
authors.forename: Zara
authors.initials: Z
authors.lastname: Dickson
authors.forename: Marie
authors.initials: M
authors.lastname: Essig
authors.forename: Philippe
authors.initials: P
authors.lastname: Honoré
authors.forename: Céline
authors.initials: C
authors.lastname: Lacour
authors.forename: Christian
authors.initials: C
authors.lastname: Lagarde
authors.forename: Maria
authors.initials: M
authors.lastname: Manescu
authors.forename: Pierre
authors.initials: P
authors.lastname: Peyronnet
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Poux
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Rerolle
authors.forename: Michel
authors.initials: M
authors.lastname: Rincé
authors.forename: Cécile
authors.initials: C
authors.lastname: Couchoud
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Aldigier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality* / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends